Delaware RegisterRegulations of Issue Date: March 1, 2005Volume 8 - Issue 9 Pages 1204 - 1338IN THIS ISSUE: Regulations: ProposedFinalGovernorExecutive OrdersAppointmentsGeneral NoticesCalendar of Events & Hearing NoticesPursuant to 29 Del. C. Chapter 11, Subchapter III, this issue of the Register contains all documents required to be published, and received, on or before February 15, 2005. DELAWARE REGISTER OF REGULATIONS The Delaware Register of Regulations is an official State publication established by authority of 69 Del. Laws, c. 107 and is published on the first of each month throughout the year. The Delaware Register will publish any regulations that are proposed to be adopted, amended or repealed and any emergency regulations promulgated. The Register will also publish some or all of the following information: •Governor’s Executive Orders •Governor’s Appointments •Attorney General’s Opinions in full text •Agency Hearing and Meeting Notices •Other documents considered to be in the public interest. CITATION TO THE DELAWARE REGISTER The Delaware Register of Regulations is cited by volume, issue, page number and date. An example would be: 8 DE Reg. 757-772 (12/01/04) Refers to Volume 8, pages 757-772 of the Delaware Register issued on December 1, 2004. SUBSCRIPTION INFORMATION The cost of a yearly subscription (12 issues) for the Delaware Register of Regulations is $135.00. Single copies are available at a cost of $12.00 per issue, including postage. For more information contact the Division of Research at 302-744-4114 or 1-800-282-8545 in Delaware. CITIZEN PARTICIPATION IN THE REGULATORY PROCESS Delaware citizens and other interested parties may participate in the process by which administrative regulations are adopted, amended or repealed, and may initiate the process by which the validity and applicability of regulations is determined. Under 29 Del.C. §10115 whenever an agency proposes to formulate, adopt, amend or repeal a regulation, it shall file notice and full text of such proposals, together with copies of the existing regulation being adopted, amended or repealed, with the Registrar for publication in the Register of Regulations pursuant to §1134 of this title. The notice shall describe the nature of the proceedings including a brief synopsis of the subject, substance, issues, possible terms of the agency action, a reference to the legal authority of the agency to act, and reference to any other regulations that may be impacted or affected by the proposal, and shall state the manner in which persons may present their views; if in writing, of the place to which and the final date by which such views may be submitted; or if at a public hearing, the date, time and place of the hearing. If a public hearing is to be held, such public hearing shall not be scheduled less than 20 days following publication of notice of the proposal in the Register of Regulations. If a public hearing will be held on the proposal, notice of the time, date, place and a summary of the nature of the proposal shall also be published in at least 2 Delaware newspapers of general circulation. The notice shall also be mailed to all persons who have made timely written requests of the agency for advance notice of its regulation-making proceedings. The opportunity for public comment shall be held open for a minimum of 30 days after the proposal is published in the Register of Regulations. At the conclusion of all hearings and after receipt, within the time allowed, of all written materials, upon all the testimonial and written evidence and information submitted, together with summaries of the evidence and information by subordinates, the agency shall determine whether a regulation should be adopted, amended or repealed and shall issue its conclusion in an order which shall include: (1) A brief summary of the evidence and information submitted; (2) A brief summary of its findings of fact with respect to the evidence and information, except where a rule of procedure is being adopted or amended; (3) A decision to adopt, amend or repeal a regulation or to take no action and the decision shall be supported by its findings on the evidence and information received; (4) The exact text and citation of such regulation adopted, amended or repealed; (5) The effective date of the order; (6) Any other findings or conclusions required by the law under which the agency has authority to act; and (7) The signature of at least a quorum of the agency members. The effective date of an order which adopts, amends or repeals a regulation shall be not less than 10 days from the date the order adopting, amending or repealing a regulation has been published in its final form in the Register of Regulations, unless such adoption, amendment or repeal qualifies as an emergency under §10119. Any person aggrieved by and claiming the unlawfulness of any regulation may bring an action in the Court for declaratory relief. No action of an agency with respect to the making or consideration of a proposed adoption, amendment or repeal of a regulation shall be subject to review until final agency action on the proposal has been taken. When any regulation is the subject of an enforcement action in the Court, the lawfulness of such regulation may be reviewed by the Court as a defense in the action. Except as provided in the preceding section, no judicial review of a regulation is available unless a complaint therefor is filed in the Court within 30 days of the day the agency order with respect to the regulation was published in the Register of Regulations. CLOSING DATES AND ISSUE DATES FOR THE DELAWARE REGISTER OF REGULATIONS ISSUE CLOSING CLOSING DATE DATE TIME APRIL 1MARCH 154:30 P.M. MAY 1APRIL 154:30 P.M. JUNE 1MAY 154:30 P.M. JULY 1JUNE 154:30 P.M. AUGUST 1JULY 154:30 P.M. DIVISION OF RESEARCH STAFF: Deborah A. Porter, Interim Supervisor; Sandra F. Clark, Administrative Specialist II; Kathleen Morris, Unit Operations Support Specialist; Jeffrey W. Hague, Registrar of Regulations; Steve Engebretsen, Assistant Registrar; Victoria Schultes, Administrative Specialist II; Rochelle Yerkes, Administrative Specialist II; Rhonda McGuigan, Administrative Specialist I; Ruth Ann Melson, Legislative Librarian; Lisa Schieffert, Research Analyst; Judi Abbott, Administrative Specialist I; Alice W. Stark, Legislative Attorney; Ted Segletes, Paralegal; Deborah J. Messina, Print Shop Supervisor; Marvin L. Stayton, Printer; Don Sellers, Printer. Cumulative Tables........................................................ 1209 PROPOSED DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 100 Board of Accountancy........................................... 1216 700 Board of Chiropractic............................................ 1218 1900 Board of Nursing................................................. 1219 2600 Board of Physical Therapists and Athletic Trainers................................................................ 1233 3100 Board of Funeral Services................................... 1241 DEPARTMENT OF EDUCATION 525 Requirements for Career-Technical Education Programs.............................................. 1243 545 K-12 School Counseling Program......................... 1245 727 Credit for Experience for Administrators, Teachers and Specialists....................................... 1246 731 School Food Service Employees........................... 1248 733 Substitutes............................................................. 1249 PROFESSIONAL STANDARDS BOARD 334 Standard Certificate Marketing Education Teacher................................................................. 1250 1555 Standard Certificate Early Care and Education (Ages 0 - K) Teacher........................... 1252 DIVISION OF PUBLIC HEALTH 461 Regulations Governing the Production and Sale of Milk and Milk Products.................................... 1255 DIVISION OF SOCIAL SERVICES TANF and Food Stamp Employment Training Program.................................................. 1256 DSSM; Long Term Care Program, 20330.4.1 Annuities............................................................... 1262 20700.6 Attendant Services Waiver Program (ASWP).......................................................... 1263 DEPARTMENT OF INSURANCE 702 Required Disclosures for Residential Homeowners Policies............................................ 1264 DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF WATER RESOURCES 7408 TMDLs for the Murderkill River Watershed............................................................. 1266 DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 100 Board of Accountancy.......................................... 1269 500 Board of Podiatry.................................................. 1273 2700 Board of Professional Land Surveyors............... 1280 2900 Real Estate Commission..................................... 1283 3100 Board of Funeral Directors................................. 1285 3800 State Committee on Dietetics/Nutrition.............. 1288 DEPARTMENT OF AGRICULTURE THOROUGHBRED RACING COMMISSION Rule 11.14.1.5, Scratches............................................. 1289 Rule 19.3.1.1, Application for Review........................ 1289 DEPARTMENT OF EDUCATION 401 Major Capitol Improvement Program................... 1295 PROFESSIONAL STANDARDS BOARD 309 Certification Administrative Supervisor of Special Education, Repeal of................................ 1297 307 Standard Certificate Director of Special Education (transferred to 1523)............................ 1299 1523 (previously 307) Standard Certificate Director of Special Education............................................. 1299 1531 Standard Certificate School Leader I.................. 1301 DIVISION OF SOCIAL SERVICES Private Duty Nursing Program Provider Specific Policy................................................................... 1303 DSSM: 11004.7 Child Care Subsidy Program............ 1310 DSSM 20300.2 and 20360, Long Term Care Eligibility Process................................................. 1312 DSSM 20330.7 U.S. Savings Bonds............................ 1313 DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF FISH & WILDLIFE Non-Tidal Finfish; 3308 Fish Stocking Practices................................ 1315 Tidal Finfish; 3553 River Herring Creel Limit............................ 1315 DEPARTMENT OF SAFETY AND HOMELAND SECURITY Bounty Hunters/Bail Enforcement Agents................... 1316 GOVERNOR Executive Order 64, Reallocation of State Private Activity Bond Volume Cap for Calendar Year 2004 and Initial Suballocation of State Private Activity Bond Volume Cap for Calendar Year 2005......................................... 1320 Appointments............................................................... 1321 GENERAL NOTICES DELAWARE STATE FIRE PREVENTION COMMISSION Policy For The Complaint Investigation and Resolution Process................................................................. 1326 DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF AIR AND WASTE MANAGEMENT Delaware 2002 Milestone Compliance Demonstration for Kent and New Castle Counties........................ 1327 CALENDAR OF EVENTS/HEARING NOTICES Dept. of Administrative Services, Div. of Professional Regulation, Notices of Public Hearings: Board of Accountancy.......................................... 1335 Board of Chiropractic............................................ 1335 Board of Nursing................................................... 1335 Board of Physical Therapists and Athletic Trainers.......................................................... 1336 Board of Funeral Services.................................... 1336 State Board of Education Monthly Meeting................ 1336 Dept. of Health & Social Service, Div. of Public Health; Notice of Public Hearing, Regulations Governing the Production and Sale of Milk and Milk Products................................................ 1336 Div. of Social Services Notice of Comment Periods TANF and Food Stamp Employment Training Program.......................................... 1337 Annuities....................................................... 1337 Attendant Services Waiver Program (ASWP)......................................................... 1337 Dept. of Insurance, Notice of Public Hearing Required Disclosures for Residential Homeowners Policies........................................... 1338 DNREC, Div. of Water Resources; Notice of Public Hearing, TMDLs for the Murderkill River Watershed...................................................... 1338 Delaware River Basin Commission............................. 1338 DELAWARE MANUFACTURED HOME RELOCATION TRUST FUND 201 Delaware Manufactured Home Relocation Trust Fund Regulations......................................8 DE Reg. 619 (Prop.) DELAWARE RIVER BASIN COMMISSION Proposed Amendment to the Water Quality Regulations, Water Code and Comprehensive Plan to Classify the Lower Delaware River as Special Protection Waters.............................8 DE Reg. 513 (Prop.) Proposed Amendment to the Water Quality Regulations, Water Code and Comprehensive Plan to Establish Pollutant Minimization Plan Requirements for Point and Non-Point Source Discharges of Toxic Pollutants Following Issuance of a TMDL by either the U.S. Environmental Protection Agency or a Member State, or an Assimilative Capacity Determination by the Delaware River Basin Commission.....................................................8 DE Reg. 515 (Prop.) DELAWARE STATE FIRE PREVENTION COMMISSION State Fire Prevention Regulations....................................................................................................8 DE Reg. 6 (Prop.) 8 DE Reg. 416 (Final) DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION (TITLE 24 DELAWARE ADMINISTRATIVE CODE) 100 Board of Accountancy.....................................................................................................8 DE Reg. 944 (Prop.) 200 Board of Landscape Architects........................................................................................8 DE Reg. 625 (Prop.) 8 DE Reg. 947 (Prop.) 300 Board of Architecture......................................................................................................8 DE Reg. 953 (Prop.) 500 Board of Podiatry.............................................................................................................8 DE Reg. 955 (Prop.) 700 Board of Chiropractic......................................................................................................8 DE Reg. 627 (Prop.) 8 DE Reg. 997 (Final) 1100 Board of Dental Examiners............................................................................................8 DE Reg. 1057 (Prop.) 1400 Board of Electrical Examiners.......................................................................................8 DE Reg. 627 (Prop.) 8 DE Reg. 998 (Final) 1700 Board of Medical Practice.............................................................................................8 DE Reg. 628 (Prop.) 8 DE Reg. 750 (Errata) 1770 Board of Medical Practice Respiratory Care Advisory Council....................................8 DE Reg. 635 (Prop.) 1800 Board of Plumbing Examiners.......................................................................................8 DE Reg. 639 (Prop.) 8 DE Reg. 1000 (Final) 1900 Board of Nursing...........................................................................................................8 DE Reg. 377 (Prop.) 8 DE Reg. 757 (Prop.) 8 DE Reg. 864 (Final) 8 DE Reg. 1089 (Final) 2000 Board of Occupational Therapy Practice...............................................................8 DE Reg. 518 (Prop.) 8 DE Reg. 1063 (Prop.) 2100 Board of Examiners in Optometry.........................................................................8 DE Reg. 16 (Prop.) 8 DE Reg. 536 (Final) 8 DE Reg. 640 (Prop.) 8 DE Reg. 1002 (Final) 2500 Board of Pharmacy, Rule 16.0, Crimes Substantially Related to the Practice of Pharmacy.................................................................................................................8 DE Reg. 517 (Prop.) 8 DE Reg. 879 (Final) 2600 Board of Physical Therapists & Athletic Trainers.........................................................8 DE Reg. 772 (Prop.) 2700 Board of Professional Land Surveyors..........................................................................8 DE Reg. 774 (Prop.) 2900 Real Estate Commission........................................................................................8 DE Reg. 961 (Prop.) 3000 Board of Professional Counselors of Mental Health and Chemical Dependency Professionals ...........................................................................................................8 DE Reg. 963 (Prop.) 3100 Board of Funeral Services......................................................................................8 DE Reg. 777 (Prop.) 3300 Board of Veterinary Medicine........................................................................................8 DE Reg. 645 (Prop.) 8 DE Reg. 1105 (Final) 3500 Board of Examiners of Psychologists............................................................................8 DE Reg. 779 (Prop.) 3600 Board of Geologists.......................................................................................................8 DE Reg. 785 (Prop.) 8 DE Reg. 1105 (Final) 3700 Board of Speech/Language Pathologists, Audiologists & Hearing Aid Dispensers.....8 DE Reg. 786 (Prop.) 8 DE Reg. 1106 (Final) 3800 State Committee on Dietitics/Nutrition.........................................................................8 DE Reg. 787 (Prop.) 3900 Board of Clinical Social Work Examiners....................................................................8 DE Reg. 218 (Prop.) 8 DE Reg. 880 (Final) 8 DE Reg. 966 (Prop.) 5100 Board of Cosmetology & Barbering..............................................................................8 DE Reg. 788 (Prop.) 5200 Board of Nursing Home Administrators........................................................................8 DE Reg. 790 (Prop.) 5300 Board of Massage and Bodywork..................................................................................8 DE Reg. 390 (Prop.) 8 DE Reg. 692 (Final) 8 DE Reg. 796 (Prop.) 8 DE Reg. 1107 (Final) Gaming Control Board, Bingo, Charitable Gambling and Raffles.........................................8 DE Reg. 531 (Final) PUBLIC INTEGRITY COMMISSION Public Integrity Commission, Rules of...................................................................................8 DE Reg. 710 (Final) PUBLIC SERVICE COMMISSION Reg. Docket No. 15, Concerning the Terms and Conditions Under Which Water Utilities Require Advances and/or Contributions In-Aid-Of Construction from Customers or Developers, and the Proper Ratemakeing Treatment for such Contributions and Advances...................................................................................................................8 DE Reg. 969 (Prop.) Reg. Docket No. 54, Concerning the Jurisdiction of the Public Service Commission to Grant and Revoke Certificates of Public Convenience and Necessity to Provide Wastewater Services........................................................................................................8 DE Reg. 646 (Prop.) DEPARTMENT OF AGRICULTURE HARNESS RACING COMMISSION Rule 8.3.3.5, Erythropietin......................................................................................................8 DE Reg. 329 (Final) Rule 8.8 Prohibited Substances Protests; Testing...................................................................8 DE Reg. 698 (Final) Rule 8.9 Prerace Testing By Blood Gas Analyzer or Similar Equipment..............................8 DE Reg. 798 (Prop.) 8 DE Reg. 1108 (Final) Rule 8.10 Quarantine Procedure for Carbon Dioxide Positive Test (Prerace or Postrace).....8 DE Reg. 1108 (Final) Standardbred Breeder’s Fund Regulations.............................................................................8 DE Reg. 336 (Final) THOROUGHBRED RACING COMMISSION Rule 11.14.1.5 Scratches.................................................................................................8 DE Reg. 652 (Prop.) Rule 19.3.1.1, Application for Review...........................................................................8 DE Reg. 652 (Prop.) DEPARTMENT OF EDUCATION (TITLE 14 DELAWARE ADMINISTRATIVE CODE) 101 Delaware Student Testing Program.................................................................................8 DE Reg. 17 (Prop.) 8 DE Reg. 425 (Final) 106 Teacher Appraisal Process Delaware Performance Appraisal System (DPAS II)..........8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 107 Specialist Appraisal Process Delaware Performance Appraisal System (DPAS II)......8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 108 Administrator Appraisal Process Delaware Performance Appraisal System (DPAS II)........8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 251 Family Educational Rights and Privacy Act (FERPA)...........................................................8 DE Reg. 1112 (Final) 252 Required Educational Records and Transfer and Maintenance of Educational Records........8 DE Reg. 1112 (Final) 260 General Appeal Procedure for the Child and Adult Care Food Program of the United States Department of Agriculture CACFP/USDA ....................................................8 DE Reg. 221 (Prop.) 8 DE Reg. 537 (Final) 262 General Administrative Appeal Procedures for National School Lunch Programs (NSLP), School Breakfast Program (SBP) and the After School Snack Program (ASSP) of the United States Department of Agriculture (USDA)-Fiscal Action..........................................8 DE Reg. 1066 (Prop.) 264 General Administrative Appeal Procedures for the Summer Food Servide Programs of the United States Department of Agriculture CACFP/USDA......................................................8 DE Reg. 1068 (Prop.) 278 Non-public School Educator Licensure and Certification......................................................8 DE Reg. 811 (Prop.) 8 DE Reg. 1123 (Final) 501 State Content Standards..........................................................................................................8 DE Reg. 36 (Prop.) 8 DE Reg. 445 (Final) 609 District and School Based Intervention Services....................................................................8 DE Reg. 657 (Prop.) 8 DE Reg. 1008 (Final) 611 Consortium Discipline Alternative Programs for Treatment of Severe Discipline Problems8 DE Reg. 657 (Prop.) 8 DE Reg. 1008 (Final) 618 (Formerly Reg. 879) School Safety Audit..............................................................................8 DE Reg. 344 (Final) 620 (Formerly Reg. 880) School Crisis Response Plans...............................................................8 DE Reg. 344 (Final) 701 Unit Count.............................................................................................................................8 DE Reg. 1070 (Prop.) 705 Training Camp and Special Duty in the National Guard and/or Reserves..............................8 DE Reg. 396 (Prop.) 8 DE Reg. 700 (Final) 706 Credit for Experience for Full Time Service in the Armed Forces.........................................8 DE Reg. 397 (Prop.) 8 DE Reg. 701 (Final) 712 Employee Leave......................................................................................................................8 DE Reg. 1073 (Prop.) 714 Professional Employee Work Stoppage or Strike...................................................................8 DE Reg. 820 (Prop.) 8 DE Reg. 1132 (Final) 718 Health Examinations for School District Employees.....................................................8 DE Reg. 37 (Prop.) 8 DE Reg. 399 (Prop.) 8 DE Reg. 702 (Final) 725 School Administrator Contracts/Agreements.........................................................................8 DE Reg. 821 (Final) 8 DE Reg. 1133 (Final) 742 Compensation of District Personnel Under Specific Project Proposals................................8 DE Reg. 520 (Prop.) 8 DE Reg. 884 (Final) 805 The School Health Tuberculosis (TB) Control Program................................................8 DE Reg. 38 (Prop.) 8 DE Reg. 400 (Prop.) 8 DE Reg. 822 (Prop.) 8 DE Reg. 1134 (Final) 851 K-12 Compreshensive Health Education Program.................................................................8 DE Reg. 661 (Prop.) 8 DE Reg. 1012 (Final) 852 Child Nutrition.......................................................................................................................8 DE Reg. 224 (Prop.) 8 DE Reg. 540 (Final) 885 Safe Management and Disposal of Surplus Chemicals in the Delaware Public School System................................................................................................................................8 DE Reg. 345 (Final) 925 Children with Disabilities.......................................................................................................8 DE Reg. 225 (Prop.) 8 DE Reg. 402 (Prop.) 8 DE Reg. 886 (Final) 940 Early Admission to Kindergarten for Gifted Students............................................................8 DE Reg. 1074 (Prop.) 1105 School Transportation...........................................................................................................8 DE Reg. 237 (Final) 8 DE Reg. 541 (Final) REGULATIONS REPEALED 250 Procedures Related to the Collection, Maintenance and Disclosure of Student Data, Repeal of..........................................................................................................................8 DE Reg. 800 (Prop.) 8 DE Reg. 1112 (Final) 610 Treatment of Severe Discipline Problems Component (14 Del.C. §1604 of Chapter 16, Comprehensive School Discipline Improvement Program August 1998........................8 DE Reg. 657 (Prop.) 8 DE Reg. 1008 (Rep.) PROFESSIONAL STANDARDS BOARD 307 Certification Administrative - Director of Special Education........................................8 DE Reg. 825 (Prop.) 309 Certification Administrative - Supervisor of Special Education, Repeal of...................8 DE Reg. 827 (Prop.) 323 Certification Computer Science Teacher................................................................................8 DE Reg. 247 (Prop.) 8 DE Reg. 552 (Final) 331 (Transferred to 1566) Certification Family and Consumer Sciences Teacher........................8 DE Reg. 248 (Prop.) 8 DE Reg. 553 (Final) 368 Certification School Psychologist...................................................................................8 DE Reg. 41 (Prop.) 1501 Knowledge, Skills And Responsibility Based Supplements For Educators.................8 DE Reg. 73 (Final) 8 DE Reg. 828 (Prop.) 8 DE Reg. 1137 (Final) 1502 Educator Mentoring..............................................................................................................8 DE Reg. 347 (Final) 1505 Professional Growth Programs.....................................................................................8 DE Reg. 78 (Final) 1509 Meritorious New Teacher Candidate Designation...............................................................8 DE Reg. 446 (Final) 1528 Foreign Language Teacher Comprehensive..................................................................8 DE Reg. 80 (Final) 1529 Foreign Language Teacher Secondary..........................................................................8 DE Reg. 80 (Final) 1531 Certification Administrative - School Leader I.............................................................8 DE Reg. 832 (Prop.) 1533 Foreign Language Teacher Elementary........................................................................8 DE Reg. 80 (Final) 1537 Bilingual Teacher (Spanish) Secondary........................................................................8 DE Reg. 80 (Final) 1540 Standard Certificate Science Teacher....................................................................................8 DE Reg. 834 (Prop.) 8 DE Reg. 1138 (Final) 1542 Standard Certificate Science Teacher Middle Level.............................................................8 DE Reg. 837 (Prop.) 8 DE Reg. 1139 (Final) 1554 Standard Certificate Reading Specialist................................................................................8 DE Reg. 405 (Prop.) 8 DE Reg. 899 (Final) 1558 Bilingual Teacher (Spanish) Primary Middle Level.....................................................8 DE Reg. 80 (Final) 1566 (Formerly Reg. 331) Standard Certificate Family & Consumer Sciences Teacher..............8 DE Reg. 553 (Final) 1577 (Formerly Reg. 368) Standard Certificate-School Psychologist .........................................8 DE Reg. 448 (Final) 1584 Permits Paraeducators...........................................................................................................8 DE Reg. 839 (Prop.) 8 DE Reg. 1141 (Final) DEPARTMENT OF FINANCE DIVISION OF REVENUE Tobacco Quarterly Escrow Installments and Certification.....................................................8 DE Reg. 1075 (Prop.) OFFICE OF THE STATE LOTTERY Rule 4.2 Licensing of Technology Providers..........................................................................8 DE Reg. 842 (Prop.) 8 DE Reg. 1143 (Final) Rule 6.34 & 6.35 Agents........................................................................................................8 DE Reg. 842 (Prop.) 8 DE Reg. 1143 (Final) Rule 7.16.2 Game Requirements............................................................................................8 DE Reg. 842 (Final) 8 DE Reg. 1143 (Final) DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF LONG TERM CARE RESIDENTS PROTECTION Assisted Living Facilities, Regulations for.....................................................................8 DE Reg. 46 (Prop.) 8 DE Reg. 85 (Final) Training & Qualifications for Nursing Assistants & Certified Nursing Assistants........8 DE Reg. 662 (Prop.) 8 DE Reg. 1014 (Final) DIVISION OF PUBLIC HEALTH 4107 Testing of Newborn Infants for Metabolic, Hematologic and Endocrinologic Disorders8 DE Reg. 100 (Final) 4108 Autism Surveillance and Registration Program.............................................................8 DE Reg. 972 (Prop.) 4203 Cancer Treatment Program....................................................................................8 DE Reg. 107 (Final) 8 DE Reg. 509 (Emer.) 8 DE Reg. 850 (Prop.) 8 DE Reg. 1144 (Final) 4463 Licensing and Registration of Operators of Public Water Supply Systems...........8 DE Reg. 47 (Prop.) 8 DE Reg. 453 (Final) DIVISION OF SOCIAL SERVICES Private Duty Nursing Program Provider Specific Policy;...............................................8 DE Reg. 975 (Prop.) Provider Contractual/Programmatic Responsibilities, Section 1.6..................................8 DE Reg. 854 (Prop.) 8 DE Reg. 1148 (Final) Division of Social Services Manual (DSSM) Client Cost Sharing for Pharmaceutical Services............................................................8 DE Reg. 664 (Prop.) 8 DE Reg. 1017 (Final) 2001.1 and 2001.1.1 Redetermination: Eligibility Review Periods................................8 DE Reg. 855 (Prop.) 8 DE Reg. 1150 (Final) 3003 Non-Time Limited Program-Children’s Program...................................................8 DE Reg. 670 (Prop.) 8 DE Reg. 1024 (Final) 3031 Work for your Welfare............................................................................................8 DE Reg. 670 (Prop.) 8 DE Reg. 1024 (Final) 5311 Notification of Time and Place of Hearing.............................................................8 DE Reg. 351 (Final) 8 DE Reg. 376 (Errata) 9026.1, Food Stamp Program..........................................................................................8 DE Reg. 521 (Prop.) 8 DE Reg. 901 (Final) 9028.1, Joint Application Processing..............................................................................8 DE Reg. 1076 (Prop.) 9032.6 Residency (Including Homelessness Definition).................................................8 DE Reg. 857 (Prop.) 8 DE Reg. 1153 (Final) 9068.1 Certification Period Length.........................................................................8 DE Reg. 113 (Final) 11002.9, Child Care Subsidy Program - Definitions and Explanation Of Terms; 11004.4.1 Explanation of Certificates; 11006.4.2 Fee Paying Clients............................8 DE Reg. 407 (Prop.) 8 DE Reg. 1154 (Final) 11004.7, Child Care Subsidy Program - Determination of the Child Care Parent Fee and Fee Waiving Situations......................................................................................8 DE Reg. 978 (Prop.) 20300.2 and 20360, Long Term Care Eligibility Process................................................8 DE Reg. 980 (Prop.) 20330.7, U.S. Savings Bonds..........................................................................................8 DE Reg. 981 (Prop.) 20700.5-20700.5.8, Acquired Brain Injury Waiver Program..........................................8 DE Reg. 250 (Prop.) 8 DE Reg. 555 (Final) 8 DE Reg. 616 (Errata) DEPARTMENT OF INSURANCE 301 Audited Financial Reports......................................................................................................8 DE Reg. 252 (Prop.) 8 DE Reg. 557 (Final) 504 (Formerly Reg. No. 47) Education for Insurance Agents, Brokers, Surplus Lines Brokers and Consultants.........................................................................................................8 DE Reg. 409 (Prop.) 8 DE Reg. 703 (Final) 603 Delaware Motorists Protection Act.........................................................................................8 DE Reg. 1158 (Final) 606 (Formerly Reg. No. 31) Proof of Automobile Insurance................................................8 DE Reg. 55 (Prop.) 607 (Formerly Reg. No. 37) Defensive Driving Course Discount Automobiles and Motorcycles.....................................................................................................................8 DE Reg. 59 (Prop.) 8 DE Reg. 460 (Final) 1310 Standards for Prompt, Fair & Equitable Settlement of Claims for Helath Care Services....8 DE Reg. 1077 (Prop.) 1404 Long-Term Care Insurance...................................................................................................8 DE Reg. 257 (Prop.) 8 DE Reg. 562 (Final) 1501 Medicare Supplement Insurance Minimum Standards.................................................8 DE Reg. 62 (Prop.) 8 DE Reg. 465 (Final) 8 DE Reg. 672 (Prop.) 8 DE Reg. 1026 (Final) DEPARTMENT OF LABOR COUNCIL ON APPRENTICESHIP & TRAINING Section 106.5, Standards of Apprenticeship...................................................................8 DE Reg. 65 (Prop.) 8 DE Reg. 468 (Final) DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL OFFICE OF THE SECRETARY Green Energy Fund Program Regulation........................................................................8 DE Reg. 114 (Final) DIVISION OF AIR AND WASTE MANAGEMENT-AIR QUALITY MANAGEMENT SECTION 1352 Above Ground Storage Tank Regulations.....................................................................8 DE Reg. 677 (Prop.) 8 DE Reg. 1167 (Final) Hazardous Waste, Regulations Governing.............................................................................8 DE Reg. 352 (Final) Reporting of a Discharge of a Pollutant or Air Contaminant.........................................8 DE Reg. 126 (Final) Solid Waste, Regulations Governing......................................................................................8 DE Reg. 354 (Final) Reg. 43, Heavy Duty Diesel Engine Standards......................................................................8 DE Reg. 672 (Prop.) 8 DE Reg. 1162 (Final) Reg. 45, Excessive Idling of Heavy Duty Vehicles................................................................8 DE Reg. 982 (Prop.) DIVISION OF FISH & WILDLIFE 4.0 Seasons & 7.0 Deer...........................................................................................................8 DE Reg. 355 (Final) 3308 (Formerly NT-7) Fish Stocking Practices......................................................................8 DE Reg. 374 (Emer.) 8 DE Reg. 858 (Prop.) 3502 Striped Bass Spawning Season and Area Restrictions..................................................8 DE Reg. 858 (Prop.) 8 DE Reg. 1169 (Final) 3505 Striped Bass Commercial Fishing Seasons; Quotas; Tagging & Reporting Requirements...........................................................................................8 DE Reg. 858 (Prop.) 8 DE Reg. 1169 (Final) 3507 Black Sea Bass Size Limits; Trip Limits; Seasons; Quotas...........................................8 DE Reg. 1080 (Prop.) 3511 Summer Flounder Size Limits; Possession Limits; Seasons.........................................8 DE Reg. 1080 (Prop.) 3553 River Herring Creel Limit..............................................................................................8 DE Reg. 858 (Prop.) DIVISION OF SOIL AND WATER CONSERVATION 5101 Sediment and Stormwater Regulations..........................................................................8 DE Reg. 1172 (Final) DIVISION OF WATER RESOURCES Design, Installation and Operation of On-Site Wastewater Treatment and Disposal Systems, Regulations Governing.....................................................................................8 DE Reg. 283 (Prop.) Surface Water Quality Standards....................................................................................8 DE Reg. 154 (Final) Water Pollution, Regulations Governing................................................................................8 DE Reg. 679 (Prop.) 7101 Design, Installation and Operation of On-Site Wastewater Treatment & Disposal Systems, Regulations Governing.....................................................................................8 DE Reg. 861 (Prop.) 7203 Control of Water Pollution, Regulations Governing, Sect. 9.0, Subsection 9.4, The Concentrated Animal Feeding Operation........................................................................8 DE Reg. 984 (Prop.) 8 DE Reg. 1189 (Final) 7409 TMDL’s for Little Assowoman Bay Watershed.............................................................8 DE Reg. 688 (Prop.) 8 DE Reg. 1027 (Final) DEPARTMENT OF SAFETY AND HOMELAND SECURITY Board of Examiners of Private Investigators and Private Security Agencies................................8 DE Reg. 325 (Final) Bounty Hunter/Bail Enforcement Agents......................................................................................8 DE Reg. 689 (Prop.) 8 DE Reg. 994 (Prop.) Division of Highway Safety Electronic Red Light Safety Program.....................................................................................8 DE Reg. 524 (Prop.) 8 DE Reg. 1029 (Final) DIVISION OF HISTORICAL AND CULTURAL AFFAIRS Historic Preservation Tax Credit........................... ..................................................8 DE Reg. 194 (Final) 8 DE Reg. 526 (Prop.) 8 DE Reg. 1031 (Final) uman Relations Commission 1502 Fair Housing Regulation................................................................................................8 DE Reg. 591 (Final) OFFICE OF THE STATE BANKING COMMISSIONER 708 (Formerly Reg. No. 5.770.0009) Establishment of a Branch Office by a Bank or Trust Company........................................................................................................8 DE Reg. 68 (Prop.) 8 DE Reg. 472 (Final) 714 Establishment of a Mobile Branch Office by a Bank or Trust Company................8 DE Reg. 68 (Prop.) 8 DE Reg. 473 (Final) 1113 Election by a Subsidiary Corporation of a Banking Organization of Trust Company to be Taxed in Accordance with Chapter 19 of Title 30..........................................8 DE Reg. 68 (Prop.) 8 DE Reg. 474 (Final) DEPARTMENT OF TRANSPORTATION Motorcycle Rider Education Courses Provider Requirements......................................................9 DE Reg. 1083 (Prop.) Appointments...............................................................................................................................8 DE Reg. 361 8 DE Reg. 479 8 DE Reg. 602 8 DE Reg. 715 8 DE Reg. 907 8 DE Reg. 1036 8 DE Reg. 1200 Executive Order No. 56, Establishing The Infant Mortality Task Force.......................................8 DE Reg. 199 Executive Order No .57, Declaring Friday, June 11, 2004 A Legal Holiday In Remembrance Of Former President Reagan..........................................................................8 DE Reg. 360 Executive Order No. 58, Relating to the Reestablishment of the Juvenile Justice Advisory Group......................................................................................................................8 DE Reg. 477 Executive Order No. 59, Implementing the Strategies for State Policies & Spending ...............8 DE Reg. 714 Executive Order No. 61, Green Infrastructure...............................................................................8 DE Reg. 905 Executive Order No. 62, Establishing a Task Force on Surface Water Management....................8 DE Reg. 1199 Executive Order No. 63, Amendment to Executive ORder Number Forty-Nine..........................8 DE Reg. 1199 MERIT EMPLOYEES RELATIONS BOARD Classification Maintenance Review Appeal Procedures...............................................................8 DE Reg. 599 (Final) DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 100 BOARD OF ACCOUNTANCY Statutory Authority: 24 Delaware Code, Section 105(a)(1) (24 Del.C. §105(a)(1)) 24 DE Admin. Code 100 PUBLIC NOTICE The Delaware Board of Accountancy in accordance with 24 Del.C. §105(a)(1) has proposed changes to its rules and regulations. The proposal amends Board Regulation 10.8: Composition of Continuing Professional Education. The regulation as amended converts the stated requirements from percentages to credit hours and adds a provision that four (4) of the required credit hours shall be in a Delaware specific ethics course approved by the Board. The regulation does not change the total number of required continuing education credit hours. A public hearing will be held on April 20, 2005 at 9:00 a.m. in the second floor Conference Room B of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware where members of the public can offer comments. Anyone wishing to receive a copy of the proposed regulation may obtain a copy from the Delaware Board of Accountancy, 861 Silver Lake Blvd, Cannon Building, Suite 203, Dover DE 19904. Persons wishing to submit written comments may forward these to the Board at the above address. The final date to receive written comments will be at the public hearing. The Board will consider promulgating the proposed regulation at its regularly scheduled meeting following the public hearing. 100 Board of Accountancy 10.0Continuing Education 10.1Hours Required: Each permit holder must have completed at least 80 hours of acceptable continuing professional education each biennial reporting period of each year ending with an odd number. The eighty hours of acceptable continuing professional education submitted must have been completed in the immediately preceding two-year period. 10.2Reporting Requirements: The Board will mail permit renewal forms which provide for continuing professional education reporting to all permit holders. Each candidate for renewal shall submit a summary of their continuing education hours, along with any supporting documentation requested by the Board, to the Board at least 60 days prior to the permit renewal date set by the Division of Professional Regulation. 10.3Proration: Prorated continuing professional education regulations consisting of less than eighty hours shall only apply to the first permit renewal, thereafter all permit holders are required to complete at least eighty hours of acceptable continuing professional education biennially. 10.3.1If the initial permit was issued less than one year prior to the renewal date, there shall be no continuing education requirement for that period. 10.3.2If the initial permit was issued at least one year, but less than two years prior to the renewal date, the continuing education requirement shall be 40 hours for that period. 10.4Exceptions: The Board has the authority to make exceptions to the continuing professional education requirements for reasons including, but not limited to, health, military service, foreign residency, and retirement. 10.5Qualified Programs. 10.5.1General Determination: The overriding consideration in determining if a specific program qualifies as a continuing professional education program is whether it is a formal program of learning which contributes directly to the professional competence of the permit holder. 10.5.2Formal Programs: Formal programs requiring class attendance will qualify only if: 10.5.2.1An outline is prepared in advance and the plan sponsor agrees to preserve a copy for five years or the outline is provided to the participant or both. 10.5.2.2The program is at least an hour (a fifty-minute period) in length. 10.5.2.3The program is conducted by a qualified instructor or discussion leader. 10.5.2.4A record of registration or attendance is maintained for five years or the participant is furnished with a statement of attendance, or both. 10.5.3Programs deemed approved: Provided the criteria in Sections 10.5.1 and 10.5.2 of these Rules and Regulations are met, the following are deemed to qualify for continuing professional education: 10.5.3.1Programs approved by National Association of State Boards of Accountancy (NASBA); 10.5.3.2Professional development programs of national, state and local accounting organizations; 10.5.3.3Technical sessions at meeting of national, state and local accounting organizations and their chapters; 10.5.3.4University or college courses: 10.5.3.4.1Credit courses: each semester hour credit shall equal 5 hours of continuing professional education. 10.5.3.4.2Non-credit courses: each classroom hour shall equal one hour of continuing professional education; 10.5.3.5Programs of other organizations (accounting, industrial, professional, etc.); 10.5.3.6Other organized educational programs on technical and other practice subjects including “in-house” training programs of public accounting firms. 10.5.4Correspondence and Individual Study Programs: Formal correspondence or other individual study programs which provide evidence of satisfactory completion will qualify, with the amount of credit to be determined by the Board. The Board will not approve any program of learning that does not offer sufficient evidence that the work has actually been accomplished. The maximum credit toward meeting the continuing professional education requirement with formal correspondence or other individual study programs shall not exceed 30% of the total requirement. 10.5.5Instructors and Discussion Leaders: Credit for one hour of continuing professional education will be awarded for each hour completed as an instructor or discussion leader plus two additional hours of credit for each classroom hour for research and preparation to the extent that the activity contributes to the professional competence of the registrant as determined by the Board. No credit will be awarded for repeated offerings of the same subject matter. The maximum credit toward meeting the continuing professional education requirement as an instructor or discussion leader shall not exceed 50% of the total requirement. 10.5.6Published Articles and Books: One hour credit will be granted for each 50 minute period of preparation time on a self-declaration basis to a maximum of 20 hours in each biennial reporting period. A copy of the published article must be submitted to the Board upon request. 10.5.7Committee, Dinner, Luncheon and Firm Meetings. One hour credit will be granted for each 50 minutes of participation. Credit will only be granted for those meetings which are structured as a continuing education program. 10.6Control and Reporting 10.6.1Each applicant for permit renewal shall provide a signed statement under penalty of perjury, disclosing the following information pertaining to the educational programs submitted in satisfaction of the continuing education requirements: 10.6.1.1school, firm or organization conducting course; 10.6.1.2location of course; 10.6.1.3title of course or description of content; 10.6.1.4dates attended; and 10.6.1.5hours claimed. 10.6.2The Board may verify information submitted by applicants by requesting submission of the documentation to be retained by the applicant and/or sponsor and may revoke permits for which deficiencies exist. If a Continuing Professional Education Statement submitted by an applicant for permit renewal is not approved, or if upon verification, revocation is being considered, the applicant will be notified and may be granted a period of time in which to correct the deficiencies. Any license revocation or denial of application for license renewal will proceed in accordance with the provisions of the Administrative Procedures Act, 29Del.C. §10101, et. seq. 10.7Evidence of Completion - Retention 10.7.1Primary responsibility for documenting the requirements rest with the applicant. Evidence in support of the requirements should be retained for a period of five years after completion of the educational activity. 10.7.2Sufficiency of evidence includes retention of course outlines and such signed statements of attendance as may be furnished by the sponsor. 10.7.3For courses taken for scholastic credit in accredited universities or colleges, evidence of satisfactory completion of the course will satisfy the course outline and attendance record. 10.7.4For non-credit courses at accredited universities or colleges, a statement of the hours of attendance signed by the instructor or an authorized official of the sponsoring institution, must be obtained and retained by the applicant. Course outlines may be retained by the sponsoring institution for a period of five years in lieu of retention of the outlines by the applicant. 10.8Composition of Continuing Professional Education: The biennial continuing professional education requirement shall include a minimum of 20 percent sixteen (16) credit hours in accounting and/or auditing and a minimum of 20 percent sixteen (16) credit hours in taxation and four (4) credit hours in a Delaware specific ethics course approved by the Board. The remaining forty–four (44) credithours may be satisfied by general subject matters so long as they contribute to the professional competence of the individual practitioner. Such general subject matters include, but are not limited to, the following areas: Accounting Administrative Practice Auditing Business Law Communication Arts Computer Science Economics Finance, Production and Marketing Management Services Mathematics, Statistics, Probability, and Quantitative Applications in Business Personnel Relations, Business Management and Organization Social Environment of Business Specialized Areas of Industry Taxation *Please Note: As the rest of the sections were not amended they are not being published. A complete set of the rules and regulations for the Board of Accountancy is available at: http://dpr.delaware.gov/boards/accountancy/ index.shtml DIVISION OF PROFESSIONAL REGULATION 700 BOARD OF CHIROPRACTIC Statutory Authority: 24 Delaware Code, Section 706(a)(1) (24 Del.C. §706(a)(1)) 24 DE Admin. Code 700 PUBLIC NOTICE The Delaware Board of Chiropractic in accordance with 24 Del.C. §706(a)(1) has proposed changes to its rules and regulations. The proposal amends rule 4.2.1 Continuing Education for Licensees Other Than New Licensees to provide that the maximum allowable online continuing education credits permissible in each reporting period is twelve (12) of the twenty-four (24) required hours. A public hearing will be held on April 21, 2005 at 8:45 a.m. in the second floor Conference Room B of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware where members of the public can offer comments. Anyone wishing to receive a copy of the proposed rules and regulations may obtain a copy from the Delaware Board of Chiropractic, 861 Silver Lake Blvd, Cannon Building, Suite 203, Dover DE 19904. Persons wishing to submit written comments may forward these to the Board at the above address. The final date to receive written comments will be at the public hearing. The Board will consider promulgating the proposed regulations at its regularly scheduled meeting following the public hearing. 700 Board of Chiropractic 4.0Continuing Education 4.1Continuing Education for New Licensees: 4.1.1At the time of the initial license renewal, some individuals will have been licensed for less than two (2) years. Therefore, for these individuals only, the continuing education hours will be pro-rated as follows: License Granted During First Year:Credit Hours Required: July 1 - December 3124 hours January 1 - June 3018 hours License Granted During Second Year: Credit Hours Required: July 1 - December 3112 hours January 1 - June 30 0 hours 4.2Continuing Education for Licensees other than new licensees: 4.2.1Unless otherwise excused by the Board for good cause such as illness, extended absence from the country, or unique personal hardship which is not the result of professional negligence or inadvertence, all Chiropractors seeking renewal more than two (2) years from initial licensure or reinstatement of a lapsed license must provide to the Board adequate proof of the satisfactory completion of twenty four (24) credit hours of Board approved continuing education within the immediately preceding two (2) year period. Of the required twenty four (24) credit hours of Board approved continuing education, a maximum of twelve (12) credit hours may be fulfilled by participating in online courses. 4.2.2Proof of continuing education shall be received at the Division of Professional Regulation, Dover, Delaware, no later than April 30th of the reporting year and shall be received every 2 years after such date. Continuing education completed before April 30th of the reporting year shall not be carried over to the next renewal period. The Board has the right to conduct an audit of the proof of continuing education submitted by licensees. 4 DE Reg. 1940 (6/1/01) *Please Note: As the rest of the sections were not amended they are not being published. A complete set of the rules and regulations for the Board of Chiropractic is available at: http://dpr.delaware.gov/boards/chiropractic/ index.shtml DIVISION OF PROFESSIONAL REGULATION 1900 BOARD OF NURSING Statutory Authority: 24 Delaware Code, Section 1906(1) (24 Del.C. §1906(1) 24 DE Admin. Code 1900 PUBLIC NOTICE PLEASE TAKE NOTICE pursuant to 29 Del.C. chapter 101 and 24 Del.C. §1906(1) the Delaware Board of Nursing proposes to revise its Rules and Regulations. The subject matter of the proposed revisions relates to the insertion and removal of epidural catheters by Advanced Practice Nurses and also identifies specific health care acts to be excluded from delegation by competent individuals as specified in 24 Del.C. §1921(a)(19). The proposed rule and regulation developed by the Board relating to the insertion and removal of epidural catheters provides that the insertion and removal of epidural catheters is an authorized practice for Certified Registered Nurse Anesthetists and provides that the removal of epidural catheters is authorized practice for Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse Midwives with specialized training. Pursuant to 24 Del.C. §1906(1) and Senate Bill No. 261, as amended [74 Del. Laws C. 762], the Board of Nursing is also proposing Rules and Regulations which specifically identify health care acts to be excluded from delegation to unlicensed persons by competent individuals who do not reside in a medical facility or a facility regulated pursuant to Chapter 11 of Title 16. [See 24 Del.C. §1921(19)]. A public hearing concerning these proposed changes to the Board of Nursing Rules and Regulations will be held on Wednesday, April 13, 2005 at 9:30 a.m., in the auditorium of the Carter Partnership Building, Delaware Technical and Community College, Owens Campus, Georgetown, Delaware. Anyone desiring a copy of the proposed Rules and Regulations may obtain a copy from the Delaware Board of Nursing, 861 Silver Lake Boulevard, Cannon Building, Suite 203, Dover, DE 19904, (302) 744-4515 or (302) 744-4516. Persons desiring to submit written comments on the revised rules and regulations may forward these comments to the above address. The final date to receive written comments will be April 12, 2005. Persons wishing to make comments at the public hearing on April 13, 2005 should contact Iva Boardman at the above address or by calling (302) 744- 4517. 1900 Board of Nursing 7.0Standards of Nursing Practice 7.1Authority “Standards of Nursing Practice” means those standards of practice adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards of nursing practice shall not be used to directly or indirectly affect the employment practices and deployment of personnel by duly licensed or accredited hospitals and other duly licensed or accredited health care facilities and organizations. In addition, such standards shall not be assumed the only evidence in civil malpractice litigation, nor shall they be given a different weight than any other evidence. 7.2Purpose The purpose of standards is to establish minimal acceptable levels of safe practice for the Registered and Licensed Practical Nurse, and to serve as a guide for the Board to evaluate safe and effective nursing care. 7.3Standards of Practice for the Registered and Licensed Practical Nurse 7.3.1Standards related to the Registered Nurse. 7.3.1.1The Registered Nurse shall conduct and document nursing assessments of the health status of individuals and groups by: 7.3.1.1.1Collecting objective and subjective data from observations, examinations, interviews and written records in an accurate and timely manner. The data include but are not limited to: 7.3.1.1.1.1Biophysical and emotional status and observed changes; 7.3.1.1.1.2Growth and development; 7.3.1.1.1.3Ethno-cultural, spiritual, socio-economic and ecological background; 7.3.1.1.1.4Family health history; 7.3.1.1.1.5Information collected by other health team members; 7.3.1.1.1.6Ability to perform activities of daily living; 7.3.1.1.1.7Consideration of client’s health goals; 7.3.1.1.1.8Client knowledge and perception about health status and potential, or maintaining health status; 7.3.1.1.1.9Available and accessible human and material resources; 7.3.1.1.1.10Patterns of coping and interaction. 7.3.1.1.2Sorting, selecting, reporting, and recording the data. 7.3.1.1.3Analyzing data. 7.3.1.1.4Validating, refining and modifying the data by using available resources including interactions with the client, family, significant others, and health team members. 7.3.1.1.5Evaluating data. 7.3.1.2Registered Nurses shall establish and document nursing diagnoses that serve as the basis for the strategy of care. 7.3.1.3Registered Nurses shall develop strategies of care based on assessment and nursing diagnoses. This includes, but is not limited to: 7.3.1.3.1Prescribing nursing intervention(s) based on the nursing diagnosis. 7.3.1.3.2Initiating nursing interventions through 7.3.1.3.2.1Giving care. 7.3.1.3.2.2Assisting with care. 7.3.1.3.2.3Delegating care. 7.3.1.3.3Identifying to the identification of priorities in the strategies of care. 7.3.1.3.4Setting realistic and measurable goals for implementation. 7.3.1.3.5Identifying measures to maintain comfort, to support human functions and responses, to maintain an environment conducive to well being, and to provide health teaching and counseling. 7.3.1.3.6Supervising the caregiver to whom care is delegated. 7.3.1.4Registered Nurses shall participate in the implementation of the strategy of care by: 7.3.1.4.1Providing care for clients whose conditions are stabilized or predictable. 7.3.1.4.2Providing care for clients whose conditions are critical and/or fluctuating, under the direction and supervision of a recognized authority. 7.3.1.4.3Providing an environment conducive to safety and health. 7.3.1.4.4Documenting nursing interventions and client outcomes. 7.3.1.4.5Communicating nursing interventions and client outcomes to health team members. 7.3.1.5Registered Nurses shall evaluate outcomes, which shall include the client, family, significant others and health team members. 7.3.1.5.1Evaluation data shall be appropriately documented; and 7.3.1.5.1.1Be communicated to the client, family, significant others and appropriate members of the health care team; and 7.3.1.5.1.2Used as a basis for modifying outcomes by reassessing client health status, modifying nursing diagnoses, revising strategies of care or prescribing changes in nursing interventions. 7.4Standards of Practice for the Licensed Practical Nurse 7.4.1Standards related to the Licensed Practical Nurse’s contributions to the nursing process. 7.4.1.1The Licensed Practical Nurse shall contribute to and document nursing assessments of the health status of individuals and groups by: 7.4.1.1.1Sorting, selecting, reporting, and recording the data. 7.4.1.1.2Collecting objective and subjective data from observations, examinations, interview and written records in an accurate and timely manner. The data include but are not limited to: 7.4.1.1.2.1Biophysical and emotional status and observed changes; 7.4.1.1.2.2Growth and development; 7.4.1.1.2.3Ethno-cultural, spiritual, socio-economic, and ecological background; 7.4.1.1.2.4Family health history; 7.4.1.1.2.5Information collected by other health team members; 7.4.1.1.2.6Ability to perform activities of daily living; 7.4.1.1.2.7Consideration of client’s health goals; 7.4.1.2Licensed Practical Nurses shall participate in establishing and documenting nursing diagnoses that serve as the basis for the strategy of care. 7.4.1.3Licensed Practical Nurses shall participate in developing strategies of care based on assessment and nursing diagnoses. 7.4.1.3.1Contributing to setting realistic and measurable goals for implementation. 7.4.1.3.2Participating in identifying measures to maintain comfort, to support human functions and responses to maintain an environment conducive to well-being, and to provide health teaching and counseling. 7.4.1.3.3Contributing to setting client priorities. 7.4.1.4Licensed Practical Nurses shall participate in the implementation of the strategy of care by: 7.4.1.4.1Providing care for clients whose conditions are stabilized or predictable. 7.4.1.4.2Providing care for clients whose conditions are critical and/or fluctuating, under the directions and supervision of a recognized licensed authority. 7.4.1.4.3Providing an environment conducive to safety and health. 7.4.1.4.4Documenting nursing interventions and client outcomes. 7.4.1.4.5Communicating nursing interventions and client outcomes to health team members. 7.4.1.5Licensed Practical Nurses shall contribute to evaluating outcomes by appropriately documenting and communicating to the client, family, significant others and the health care team members. 7.5Standards Related to the Registered and Licensed Practical Nurse’s Competencies and Responsibilities. 7.5.1Registered and Licensed Practical Nurses shall: 7.5.1.1Have knowledge of the statutes and regulations governing nursing and function within the legal boundaries of professional and practical nursing practice. 7.5.1.2Accept responsibility for competent nursing practice. 7.5.1.3Function as a member of the health team: 7.5.1.3.1By collaborating with other members of the health team to provide optimum care, or 7.5.1.3.2As an LPN under the direction and supervision of a recognized licensed authority. 7.5.1.4Consult with nurses, other health team members and community agencies for continuity of care and seek guidance as necessary. 7.5.1.5Obtain instruction and supervision as necessary when implementing nursing techniques. 7.5.1.6Contribute to the formulation, interpreting, implementing and evaluating of the objectives and policies related to professional and practical nursing practice within the employment setting. 7.5.1.7Participate in evaluating nurses through peer review. 7.5.1.8Report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities. 7.5.1.9Practice without discrimination as to age, race, religion, sex, sexual orientation, national origin, or disability. 7.5.1.10Respect the dignity and rights of clients regardless of social or economic status, personal attributes or nature of health problems. 7.5.1.11Respect the client’s right to privacy by protecting confidentiality unless obligated by law to disclose the information. 7.5.1.12Respect the property of clients, their families and significant others. In addition to the proceeding, the Registered Nurse shall: 7.5.1.13Delegate to others only those nursing interventions that those persons are prepared or qualified to perform. 7.5.1.14Supervise others to whom nursing interventions are delegated. 7.5.1.15Retain professional accountability for care when delegating. 7.5.1.16Teach safe practice to other health care workers as appropriate. 7.6Dispensing 7.6.1Definitions 7.6.1.1“Dispensing” means providing medication according to an order of a practitioner duly licensed to prescribe medication. The term shall include both the repackaging and labeling of medication from bulk to individual doses. 7.6.1.2“Prescription Label” - a label affixed to every prescription or drug order which contains the following information at a minimum. 7.6.1.2.1A unique number for that specific drug order. 7.6.1.2.2The date the drug was dispensed. 7.6.1.2.3The patient’s full name. 7.6.1.2.4The brand or established name and manufacturer and the strength of the drug to the extent it can be measured. 7.6.1.2.5The practitioner’s directions as found on the prescription order. 7.6.1.2.6The practitioner’s name. 7.6.1.2.7The initials of the dispensing nurse. 7.6.1.2.8The name and address of the facility or practitioner from which the drug is dispensed. 7.6.1.2.9Expiration date. 7.6.1.3“Standing order” - An order written by the practitioner which authorizes a designated registered nurse or nurses to dispense prescription drugs to his/her patients(s) according to the standards listed below. 7.6.2Authority to Dispense 7.6.2.1Registered Nurses may assume the responsibility of dispensing as defined in the Nurse Practice Act. 7.6.2.2Licensed Practice Nurses may assume the responsibility of dispensing as authorized by the Nurse Practice Act and defined in these Regulations, Section 7.6.2.2.1., 7.6.2.2.2, and 7.6.2.2.3 7.6.2.2.1Licensed Practical Nurses may provide to a patient pre-packaged medications in accordance with the order of a practitioner duly licensed to prescribe medication where such medications have been pre- packaged by a person with lawful authority to dispense drugs. 7.6.2.2.2Licensed Practical Nurses, per written order of a physician, dentist, podiatrist, advanced practice nurse, or other practitioner duly licensed to prescribe medication, may add the name of the client to a preprinted label on a pre-packaged medication. 7.6.2.2.3Licensed Practical Nurses in a licensed methadone clinic may apply a preprinted label to a pre-packaged medication. 7.6.3Standards for Dispensing 7.6.3.1All licensed nurses engaged in dispensing shall adhere to these standards. 7.6.3.1.1The medication must be prepackaged by a pharmaceutical company or prepared by a registered pharmacist. 7.6.3.1.2The nurse shall be responsible for proper drug storage of the medication prior to dispensing. 7.6.3.1.3The practitioner who originated the prescription or drug order must be on the premises or he/she or their designated coverage shall be available by telephone during the act of dispensing. 7.6.3.1.4Once a drug has been dispensed it shall not be returned for reuse by another or the same patient in an institutional setting. 7.6.3.1.5The nurse may not delegate any part of the dispensing function to any other individual who is not licensed to dispense. 7.6.3.1.6The dispensing nurse must assure compliance to the state generic substitution laws when selecting the product to be dispensed. 7.6.3.1.7The nurse-dispensed prescription may not be refillable; it requires the authority of the prescriber with each dispensing. 7.6.3.1.8A usage review process must be established for the medicines dispensed to assure proper patient usage. 7.6.3.1.9All dispensed drugs must be labeled as defined above and dispensed in proper safety closure containers that meet the standards established by the United States Pharmacopoeia for stability. 7.6.3.1.10Record keeping must include the maintenance of the original written prescription of drug order for at least three years, allow retrospective review of accountability, and provide an audit trail. All dispensing records must be maintained on site, and available for inspection by authorized agents of the Board of Health, Pharmacy, and Nursing. 7.6.3.1.11The dispensing nurse shall assume the responsibility of patient counseling of drug effects, side-effects, desired outcome, precautions, proper storage, unique dosing criteria, drug interactions, and other pertinent data, and record evidence of patient education. 7.6.3.1.12Conformance to paragraphs 6 through 11 are not necessary if the original prescription was dispensed by a pharmacist for that specific patient. 7.7Delegation 7.7.1Definitions 7.7.1.1“Accountability” - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision. 7.7.1.2“Delegation” - Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act. 7.7.1.3“Supervision” - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action. 7.7.1.4“Unlicensed Assistive Personnel” - Individuals not licensed to perform nursing tasks that are employed to assist in the delivery of client care. The term ìunlicensed assistive personnelî does not include members of the client’s immediate family, guardians, or friends; these individuals may perform incidental care of the sick in private homes without specific authority from a licensed nurse (as established in 24 Del.C. §1921(a)(4) of the Nurse Practice Act). 7.7.2Conditions 7.7.2.1The following conditions are relevant to delegation: 7.7.2.1.1Only RNs may delegate. 7.7.2.1.2The RN must be knowledgeable regarding the unlicensed assistive personnel’s education and training and have opportunity to periodically verify the individual’s ability to perform the specific tasks. 7.7.2.1.3The RN maintains accountability for determining the appropriateness of all delegated nursing duties and responsibility for the delivery of safe and competent care. Unlicensed assistive personnel may not reassign a delegated act. 7.7.3Criteria 7.7.3.1The RN may delegate only tasks that are within the scope of sound professional nursing judgment to delegate. 7.7.3.2Determination of appropriate factors include, but are not limited to: 7.7.3.2.1stability of the client’s condition 7.7.3.2.2educational background, skill level, or preparation of the individual 7.7.3.2.3nature of the nursing act that meets the following: 7.7.3.2.3.1task is performed frequently in the daily care of a client 7.7.3.2.3.2task is performed according to an established sequence of steps 7.7.3.2.3.3task may be performed with a predictable outcome 7.7.3.2.3.4task does not involve ongoing assessment, interpretation or decision making that cannot be logically separated from the task itself. 7.7.3.3The RN must be readily available in person or by telecommunication. 7.7.4Exclusions 7.7.4.1The following activities require nursing knowledge, judgment, and skill and may not be delegated by the RN to an unlicensed assistive person. These exclusions do not apply to Advanced Practice Nurses. 7.7.4.2Physical, psychological, and social assessment which requires professional nursing judgment, intervention, referral, or follow-up; 7.7.4.3Development of nursing diagnosis and care goals; 7.7.4.4Formulation of the plan of nursing care and evaluation of the effectiveness of the nursing care provided; 7.7.4.5Specific tasks involved in the implementation of the plan of care which require nursing judgment, skill, or intervention, that include, but are not limited to: performance of sterile invasive procedures involving a wound or anatomical site; nasogastric, newly established gastrostomy and jejunostomy tube feeding; nasogastric, jejunostomy and gastrostomy tube insertion or removal; suprapubic catheter insertion and removal; (phlebotomy is not considered a sterile, invasive procedure); 7.7.4.6Administration of medications, including prescription topical medications; and 7.7.4.7Receiving or transmitting verbal orders. 1 DE Reg. 1888 (6/1/98) 6 DE Reg. 1195 (3/1/03) 7.8Intravascular Therapy By Licensed Nurses Intravascular therapy encompasses several components, some of which require primarily skill proficiency with a minimum of critical judgement. Other aspects of intravascular therapy require skill proficiency and more importantly a high degree of knowledge, critical judgement and decision making to perform the function safely. 7.8.1Definition Of Terms 7.8.1.1Vascular system - is composed of all peripheral and central veins and arteries. 7.8.1.2Intravascular therapy (IV) - is the broad term including the administration of fluids and medications, blood and blood derivatives into an individual's vascular system. 7.8.1.3Intravenous fluids - include solutions, vitamins, nutrient preparations, and commercial blood fractions designed to be administered into an individual's vascular system. Whole blood and blood components, which are administered in the same manner, are considered intravenous fluids in this definition. 7.8.1.4Intravenous and intra-arterial medications - are drugs administered into an individual's vascular system by any one of the following methods: 7.8.1.4.1By way of infusion diluted in solution or suspended in fluid and administered over a specified time at a specified rate. 7.8.1.4.2Through an established intra- vascular needle or catheter (referred to as "IV push"). 7.8.1.4.3By venipuncture carried out for the sole purpose of administering the medication. This method is referred to as direct medication injection (direct IV push). 7.8.1.5Vascular access - Utilization of an established device or the introduction of a needle or catheter into an individual’s vascular system. 7.8.1.6Venipuncture - Introduction of a needle or catheter into an individual's peripheral vein for the purpose(s) of withdrawing blood or establishing an infusion or administering medications. 7.8.1.7Intravascular therapy maintenance - Monitoring of the therapy for changes in patient's condition, appropriate flow rate, equipment function, the hanging of additional fluid containers and the implementation of site care. 7.8.1.8Termination of intravascular therapy - Cessation of the therapy either by withdrawing a needle or catheter from an individual’s vascular system or by discontinuing the infusion and maintaining the device as a reservoir. 7.8.1.9Supervision - a registered nurse, licensed physician or dentist is physically present in the unit where the patient is being provided care, or within immediate electronic/telephone contact. 7.8.2Conditions Of Performing Intravascular Therapy Procedures By Licensed Nurses 7.8.2.1Intravascular therapy must be authorized by a written order from a state licensed and authorized prescriber. 7.8.2.2The performance of any procedures of intravascular therapy by a licensed practical nurse will be done under the supervision of a registered nurse, APN, or person licensed to practice medicine, surgery, or podiatry. 7.8.2.3Admixed intravascular solutions documented and instituted by one licensed nurse and subsequently interrupted may be re-instituted by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.4Admixed intravascular solutions documented and prepared by one licensed nurse may be initiated or continued by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.5Intradermal or topical anesthetics may be used by the RN or LPN when initiating vascular access therapy in various situations or settings, provided there is an authorized prescriber’s order and organizational policy/ procedure to support use of these medications. All RNs and LPNs must have documented educational preparation according to the employing agency’s policies and procedures. Documented evidence must include both theoretical instruction including anatomy and physiology, pharmacology, nursing management and education of patients and demonstration of clinical proficiency in performance of the task. 7.8.3Functional Scope Of Responsibility For Intravascular Therapy Procedures 7.8.3.1Registered Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following: 7.8.3.1.1Assessment of the patient and the prescribed intravascular therapy before, during and after the therapy is carried out. 7.8.3.1.2Acceptance and confirmation of intravascular therapy order(s). 7.8.3.1.3Calculation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.4Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.5Addition of prescribed medications in intravascular solution, labeling and documenting appropriately. 7.8.3.1.6Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.1.7Vascular access for establishing an infusion or administering medications. 7.8.3.1.8Administration of medications by "IV push". 7.8.3.1.9Intravascular therapy maintenance. 7.8.3.1.10Termination of intravascular therapy, including the removal of subclavian and PICC lines. 7.8.3.1.11Access the vascular system for the purpose of the withdrawal of blood and to monitor the patient's condition before, during, and after the withdrawal of blood. 7.8.3.2Licensed Practical Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following for peripheral lines: 7.8.3.2.1Acceptance of intravascular therapy order(s). 7.8.3.2.2Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.2.3Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.2.4Addition of mediations in intravascular solutions, label and document appropriately. 7.8.3.2.5Venipuncture with needle device to establish access to the peripheral vascular system. 7.8.3.2.6Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.2.7Intravascular therapy maintenance including the flushing of peripheral lines with Heparin and/or saline solution. 7.8.3.2.8Termination of peripheral intravascular therapy. 7.8.3.2.9Performance of venipuncture for the purpose of the withdrawal of blood and to monitor the patient's condition before, during and after the withdrawal of blood. 7.8.3.3The Licensed Practical Nurse is permitted to perform the following procedures for central lines: 7.8.3.3.1Acceptance of intravascular therapy order(s). 7.8.3.3.2Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.3.3Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.3.4Addition of medications in intravascular solutions, label and document appropriately. 7.8.3.3.5Intravascular therapy maintenance, including the flushing of central lines with Heparin and/or saline solution. 7.8.3.3.6Dressing and tubing changes, including PICC lines. 7.8.3.3.7Addition of replacement fluids to an existing infusion as prescribed. 7.8.4Special Intravascular Procedures By Registered Nurses 7.8.4.1Chemotherapy - Only intravascular routes are addressed in these rules. Review of the Oncology Nursing Society’s current guidelines is recommended before the administration of anti-neoplastic agents. 7.8.4.1.1Definition of Terms 7.8.4.1.1.1Cancer Chemotherapy- is the broad term including the administration of anti- neoplastic agents into an individual's vascular system. 7.8.4.1.1.2Anti-neoplastic agents- are those drugs which are administered with the intent to control neoplastic cell growth. 7.8.4.1.2The Registered Nurse who administers cancer chemotherapy by the intravascular route must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.1.3The Registered Nurse must have documented evidence of knowledge and skill in the following: Pharmacology of anti-neoplastic agents Principles of drug handling and preparation Principles of administration Vascular access Side effects of chemotherapy on the nurse, patient, and family 7.8.4.2Central Venous Access Via Peripheral Veins 7.8.4.2.1Definition of Terms 7.8.4.2.1.1Central venous access - is that entry into an individual's vascular system via the insertion of a catheter into a peripheral vein threaded through to the superior vena cava with placement confirmed by x- ray. 7.8.4.2.2The Registered Nurse who performs central venous access via peripheral veins must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.2.3Documented evidence must include, but is not limited to, evidence of both theoretical instruction and clinical proficiency in performance of the task. 7.8.4.2.3.1Theoretical instruction must include, but is not limited to, anatomy and physiology, pharmacology, nursing management, and education of patients as they relate to central venous access via peripheral veins. 7.8.4.2.3.2A preceptor must supervise the learning experience and must document the Registered Nurse's competency in the performance of the procedure. 7.8.4.3Pain Management Via Epidural Catheter 7.8.4.3.1It is within the scope of practice of a Registered Nurse to instill analgesics (opiates)/ low dose anesthetics at analgesic levels into an existing catheter under the following conditions/exceptions: 7.8.4.3.1.1The epidural catheter is in place. 7.8.4.3.1.2The position of the epidural catheter was verified as correct by a physician at the time of insertion. 7.8.4.3.1.3Bolus doses and/or continuous infusions, as pre-mixed by anesthesiologists, C.R.N.A.s, or pharmacists, of epidural analgesics/low does anesthetics at analgesic levels can be administered by the Registered Nurse only after the initial dose has been administered. Changes in medication and/or dosage of the same medication are not defined as the initial dose. 7.8.4.3.1.4Only analgesics (opiates)/low dose anesthetics at analgesic levels will be administered via this route for acute and chronic pain management. 7.8.4.3.1.5The Registered Nurse must complete a course that includes, but is not limited to, a) anatomy, physiology, pharmacology, nursing management, assessment, and education of patients as they relate to epidural administration of opiates/low dose anesthetics at analgesic levels; b) a credentialed preceptor must supervise the learning experience and must document the Registered Nurse's clinical competency in the performance of the procedure. 7.8.4.3.1.6The Registered Nurse may not insert or remove epidural catheters. 7.9Exclusions of Health Care Acts pursuant to 24 Del.C. 1921(a) (19) 7.9.1Health care acts that shall not be delegated by a competent individual who does not reside in a medical facility or a facility regulated pursuant to Chapter 11 of Title 16 include the following: 7.9.1.1original intravenous insertion 7.9.1.2original suprapubic catheter insertion or removal 7.9.1.3newly established gastrostomy or jejunostomy tube feeding 7.9.1.4original nasogastric and gastrostomy tube insertion or removal 7.9.1.5any jejunostomy tube insertion or removal 7.9.1.6sterile invasive procedures not normally taught to patients and caregivers by licensed health care professionals 8 DE Reg. 864 (12/01/04) 8.0Rules and Regulations Governing the Practice of Nursing as an Advanced Practice Nurse in the State of Delaware 8.1Authority These rules and regulations are adopted by the Delaware Board of Nursing under the authority of the Delaware Nurse Practice Act, 24 Del.C. §§1902(d), 1906(1), 1906(7). 8.2Purpose 8.2.1The general purpose of these rules and regulations is to assist in protecting and safeguarding the public by regulating the practice of the Advanced Practice Nurse. 8.3Scope 8.3.1These rules and regulations govern the educational and experience requirements and standards of practice for the Advanced Practice Nurse. Prescribing medications and treatments independently is pursuant to the Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). The Advanced Practice Nurse is responsible and accountable for her or his practice. Nothing herein is deemed to limit the scope of practice or prohibit a Registered Nurse from engaging in those activities that constitute the practice of professional nursing and/or professional nursing in a specialty area. 8.4Definitions “Advanced Practice Nurse” as defined in 24Del.C. §1902(d)(1). Such a nurse will be given the title Advanced Practice Nurse by state licensure, and may use the title Advanced Practice Nurse within his/her specific specialty area. “Audit” The verification of existence of a collaborative agreement for a minimum of 10% of the total number of licenses issued during a specified time period. “Board” The Delaware Board of Nursing “Certified Nurse Midwife (C.N.M.)” A Registered Nurse who is a provider for normal maternity, newborn and well-woman gynecological care. The CNM designation is received after completing an accredited post- basic nursing program in midwifery at schools of medicine, nursing or public health, and passing a certification examination administered by the ACNM Certification Council, Inc. or other nationally recognized, Board of Nursing approved certifying organization. “Certified Registered Nurse Anesthetist (C.R.N.A.)” A Registered Nurse who has graduated from a nurse anesthesia educational program accredited by the American Association of Nurse Anesthetists’ Council on Accreditation of Nurse Anesthesia Educational programs, and who is certified by the American Association of Nurse Anesthetists’ Council on Certification of Nurse Anesthetists or other nationally recognized, Board of Nursing approved certifying organization. “Clinical Nurse Specialist (C.N.S.)” A Registered Nurse with advanced nursing educational preparation who functions in primary, secondary, and tertiary settings with individuals, families, groups, or communities. The CNS designation is received after graduation from a Master’s degree program in a clinical nurse specialty or post Master’s certificate, such as gerontology, maternal-child, pediatrics, psych/mental health, etc. The CNS must have national certification in the area of specialization at the advanced level if such a certification exists or as specified in 8.9.4.1 of these Rules and Regulations. The certifying agency must meet the established criteria approved by the Delaware Board of Nursing. “Clinical Nursing Specialty” a delimited focus of advanced nursing practice. Specialty areas can be identified in terms of population, setting, disease/ pathology, type of care or type of problem. Nursing administration does not qualify as a clinical nursing specialty. 3 DE Reg. 1373 (4/1/00) “Collaborative Agreement” Written verification of health care facility approved clinical privileges; or health care facility approved job description; or a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system. “Guidelines/ Protocols” Suggested pathways to be followed by an Advanced Practice Nurse for managing a particular medical problem. These guidelines/ protocols may be developed collaboratively by an Advanced Practice Nurse and a licensed physician, dentist or a podiatrist, or licensed Delaware health care delivery system. “National Certification” That credential earned by a nurse who has met requirements of a Board approved certifying agency. The agencies so approved include but are not limited to: American Academy of Nurse Practitioners American Nurses Credentialing Center American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties National Certification Board of Pediatric Nurse Practitioners and Nurses. ACNM Certification Council, Inc. “Nurse Practitioner (N.P.)” A Registered Nurse with advanced nursing educational preparation who is a provider of primary healthcare in a variety of settings with a focus on a specific area of practice. The NP designation is received after graduation from a Master’s program or from an accredited post-basic NP certificate program of at least one academic year in length in a nurse practitioner specialty such as acute care, adult, family, geriatric, pediatric, or women’s health, etc. The NP must have national certification in the area of specialization at the advanced level by a certifying agency which meets the established criteria approved by the Delaware Board of Nursing. “Post Basic Program” A combined didactic and clinical/preceptored program of at least one academic year of full time study in the area of advanced nursing practice with a minimum of 400 clinical/preceptored hours. The program must be one offered and administered by an approved health agency and/or institution of higher learning, Post basic means a program taken after licensure is achieved. “Scope of Specialized Practice” That area of practice in which an Advanced Practice Nurse has a Master’s degree or a post-basic program certificate in a clinical nursing specialty with national certification. “Supervision” Direction given by a licensed physician or Advanced Practice Nurse to an Advanced Practice Nurse practicing pursuant to a temporary permit. The supervising physician or Advanced Practice Nurse must be periodically available at the site where care is provided, or available for immediate guidance. 8.5Grandfathering Period 8.5.1Any person holding a certificate of state licensure as an Advanced Practice Nurse that is valid on July 8, 1994 shall be eligible for renewal of such licensure under the conditions and standards prescribed herein for renewal of licensure. 8.6Standards for the Advanced Practice Nurse 8.6.1Advanced Practice Nurses view clients and their health concerns from an integrated multi-system perspective. 8.6.2Standards provide the practitioner with a framework within which to operate and with the means to evaluate his/her practice. In meeting the standards of practice of nursing in the advanced role, each practitioner, including but not limited to those listed in 8.6.2 of these Rules and Regulations: 8.6.2.1Performs comprehensive assessments using appropriate physical and psychosocial parameters; 8.6.2.2Develops comprehensive nursing care plans based on current theories and advanced clinical knowledge and expertise; 8.6.2.3Initiates and applies clinical treatments based on expert knowledge and technical competency to client populations with problems ranging from health promotion to complex illness and for whom the Advanced Practice Nurse assumes primary care responsibilities. These treatments include, but are not limited to psychotherapy, administration of anesthesia, and vaginal deliveries; 8.6.2.4Functions under established guidelines/protocols and/ or accepted standards of care; 8.6.2.5Uses the results of scientifically sound empirical research as a basis for nursing practice decisions; 8.6.2.6Uses appropriate teaching/learning strategies to diagnose learning impediments; 8.6.2.7Evaluates the quality of individual client care in accordance with quality assurance and other standards; 8.6.2.8Reviews and revises guidelines/ protocols, as necessary; 8.6.2.9Maintains an accurate written account of the progress of clients for whom primary care responsibilities are assumed; 8.6.2.10Collaborates with members of a multi-disciplinary team toward the accomplishment of mutually established goals; 8.6.2.11Pursues strategies to enhance access to and use of adequate health care services; 8.6.2.12Maintains optimal advanced practice based on a continual process of review and evaluation of scientific theory, research findings and current practice; 8.6.2.13Performs consultative services for clients referred by other members of the multi- disciplinary team; and 8.6.2.14Establishes a collaborative agreement with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system to facilitate consultation and/or referral as appropriate in the delivery of health care to clients. 8.6.3In addition to these standards, each nurse certified in an area of specialization and recognized by the Board to practice as an Advanced Practice Nurse is responsible for practice at the level and scope defined for that specialty certification by the agency which certified the nurse. 8.7Generic Functions of the Advanced Practice Nurse Within the Specialized Scope of Practice include but are not limited to: 8.7.1Eliciting detailed health history(s) 8.7.2Defining nursing problem(s) 8.7.3Performing physical examination(s) 8.7.4Collecting and performing laboratory tests 8.7.5Interpreting laboratory data 8.7.6Initiating requests for essential laboratory procedures 8.7.7Initiating requests for essential x-rays 8.7.8Screening patients to identify abnormal problems 8.7.9Initiating referrals to appropriate resources and services as necessary 8.7.10Initiating or modifying treatment and medications within established guidelines 8.7.11Assessing and reporting changes in the health of individuals, families and communities 8.7.12Providing health education through teaching and counseling 8.7.13Planning and/or instituting health care programs in the community with other health care professionals and the public 8.7.14Delegating tasks appropriately 8.7.15Prescribing medications and treatments independently pursuant to Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). 8.7.16Inserting and removing epidural catheters by Certified Registered Nurse Anesthetists 8.7.17Removing epidural catheters by Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse Midwives after specialized training in collaboration with the facility department of anesthesiology, including population specific advanced life support. 8.8Criteria for Approval of Certification Agencies 8.8.1A national certifying body which meets the following criteria shall be recognized by the Board to satisfy 24 Del.C. §1902(d)(1). 8.8.2The national certifying body: 8.8.2.1Is national in the scope of its credentialing. 8.8.2.2Has no requirement for an applicant to be a member of any organization. 8.8.2.3Has educational requirements which are consistent with the requirements of these rules. 8.8.2.4Has an application process and credential review which includes documentation that the applicant’s education is in the advanced nursing practice category being certified, and that the applicant’s clinical practice is in the certification category. 8.8.2.5Uses an examination as a basis for certification in the advanced nursing practice category which meets the following criteria: 8.8.2.5.1The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community; 8.8.2.5.2The examination represents the knowledge, skills and abilities essential for the delivery of safe and effective advanced nursing care to the clients; 8.8.2.5.3The examination content and its distribution are specified in a test plan (blueprint), based on the job analysis study, that is available to examinees; 8.8.2.5.4Examination items are reviewed for content validity, cultural sensitivity and correct scoring using an established mechanism, both before use and periodically; 8.8.2.5.5Examinations are evaluated for psychometric performance; 8.8.2.5.6The passing standard is established using acceptable psychometric methods, and is reevaluated periodically; and 8.8.2.5.7Examination security is maintained through established procedures 8.8.2.6Issues certification based upon passing the examination and meeting all other certification requirements. 8.8.2.7Provides for periodic recertification which includes review of qualifications and continued competency. 8.8.2.8Has mechanisms in place for communication to Boards of Nursing for timely verification of an individual’s certification status, changes in certification status, and changes in the certification program, including qualifications, test plan and scope of practice. 8.8.2.9Has an evaluation process to provide quality assurance in its certification program. 8.9Application for Licensure to Practice as an Advanced Practice Nurse 8.9.1Application for licensure as a Registered Nurse shall be made on forms supplied by the Board. 8.9.2In addition, an application for licensure to practice as an Advanced Practice Nurse shall be made on forms supplied by the Board. 8.9.2.1The APN applicant shall be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists. 8.9.2.2Notification of changes in the name of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system shall be forwarded to the Board office. 8.9.3Each application shall be returned to the Board office together with appropriate documentation and non-refundable fees. 8.9.4A Registered Nurse meeting the practice requirement as listed in 8.11 and all other requirements set forth in these Rules and Regulations may be issued a license as an Advanced Practice Nurse in the specific area of specialization in which the nurse has been nationally certified at the advanced level and/or has earned a Master’s degree in a clinical nursing specialty. 8.9.4.1Clinical nurse specialists, whose subspecialty area can be categorized under a broad scope of nursing practice for which a Board-approved national certification examination exists, are required to pass this certification examination to qualify for permanent licensure as an Advanced Practice Nurse. This would include, but not be limited to medical-surgical and psychiatric-mental health nursing. If a more specific post-graduate level certification examination that has Board of Nursing approval is available within the clinical nursing specialist’s subspecialty area at the time of licensure application, the applicant may substitute this examination for the broad-based clinical nursing specialist certification examination. 8.9.4.2Faculty members teaching in nursing education programs are not required to be licensed as Advanced Practice Nurses. Those faculty members teaching in graduate level clinical courses may apply for licensure as Advanced Practice Nurses and utilize graduate level clinical teaching hours to fulfill the practice requirement as stated in 8.11.2.1. 8.9.5Renewal of licensure shall be on a date consistent with the current Registered Nurse renewal period. A renewal fee shall be paid. 8.9.6The Board may refuse to issue, revoke, suspend or refuse to renew the license as an Advanced Practice Nurse or otherwise discipline an applicant or a practitioner who fails to meet the requirements for licensure as an Advanced Practice Nurse or as a registered nurse, or who commits any disciplinary offense under the Nurse Practice Act, 24 Del.C. Ch. 19, or the Rules and Regulations promulgated pursuant thereto. All decisions regarding independent practice and/or independent prescriptive authority are made by the Joint Practice Committee as provided in 24 Del.C. §1906(20) - (22). 8.10Temporary Permit for Advanced Practice Nurse Licensure 8.10.1A temporary permit to practice, pending Board approval for permanent licensure, may be issued provided that: 8.10.1.1The individual applying has also applied for licensure to practice as a Registered Nurse in Delaware, or 8.10.1.2The individual applying holds a current license in Delaware, and 8.10.1.3The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nursing program, and has passed the certification examination, or 8.10.1.4The individual is a graduate of a Master’s program in a clinical nursing specialty for which there is no certifying examination, and can show evidence of at least 1000 hours of clinical nursing practice within the past 24 months. 8.10.1.5Application(s) and fee(s) are on file in the Board office. 8.10.2A temporary permit to practice, under supervision only, may be issued at the discretion of the Executive Director provided that: 8.10.2.1The individual meets the requirements in 8.10.1.1 or 8.10.1.2, and 8.10.1.5 and; 8.10.2.2The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nurse program, and; 8.10.2.3The individual submits proof of admission into the approved certifying agency’s examination or is seeking a temporary permit to practice under supervision to accrue the practice hours required to sit for the certifying examination or has accrued the required practice hours and is scheduled to take the first advanced certifying examination upon eligibility or is accruing the practice hours referred to in 8.10.2.4; or, 8.10.2.4The individual meets 8.10.2.1 and 8.10.2.2 hereinabove and is awaiting review by the certifying agency for eligibility to sit for the certifying examination. 8.10.3If the certifying examination has been passed, the appropriate form must accompany the application. 8.10.4A temporary permit may be issued: 8.10.4.1For up to two years in three month periods. 8.10.4.2At the discretion of the Executive Director. 8.10.5A temporary permit will be withdrawn: 8.10.5.1Upon failure to pass the first certifying examination 8.10.5.1.1The applicant may petition the Board of Nursing to extend a temporary permit under supervision until results of the next available certification exam are available by furnishing the following information: 8.10.5.1.1.1current employer reference, 8.10.5.1.1.2supervision available, 8.10.5.1.1.3job description, 8.10.5.1.1.4letter outlining any extenuating circumstances, 8.10.5.1.1.5any other information the Board of Nursing deems necessary. 8.10.5.2For other reasons stipulated under temporary permits elsewhere in these Rules and Regulations. 3 DE Reg. 1373 (4/1/00) 8.10.6A lapsed temporary permit for designation is equivalent to a lapsed license and the same rules apply. 8.10.7Failure of the certifying examination does not impact on the retention of the basic professional Registered Nurse licensure. 8.10.8Any person practicing or holding oneself out as an Advanced Practice Nurse in any category without a Board authorized license in such category shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of the Law regulating the Practice of Nursing in Delaware, (24 Del.C. Ch. 19). 8.10.9Endorsement of Advanced Practice Nurse designation from another state is processed the same as for licensure by endorsement, provided that the applicant meets the criteria for an Advanced Practice Nurse license in Delaware. 8.11Maintenance of Licensure Status: Reinstatement 8.11.1To maintain licensure, the Advanced Practice Nurse must meet the requirements for recertification as established by the certifying agency. 8.11.2The Advanced Practice Nurse must have practiced a minimum of 1500 hours in the past five years or no less than 600 hours in the past two years in the area of specialization in which licensure has been granted. 8.11.2.1Faculty members teaching in graduate level clinical courses may count a maximum of 500 didactic course contact hours in the past five years or 200 in the past two years and all hours of direct on-site clinical supervision of students to meet the practice requirement. 8.11.2.2An Advanced Practice Nurse who does not meet the practice requirement may be issued a temporary permit to practice under the supervision of a person licensed to practice medicine, surgery, dentistry, or advanced practice nursing, as determined on an individual basis by the Board. 8.11.3The Advanced Practice Nurse will be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists. 8.11.4Advanced Practice Nurses who fail to renew their licenses by February 28, May 31, or September 30 of the renewal period shall be considered to have lapsed licenses. After February 28, May 31, or September 30 of the current licensing period, any requests for reinstatement of a lapsed license shall be presented to the Board for action. 8.11.5To reinstate licensure status as an Advanced Practice Nurse, the requirements for recertification and 1500 hours of practice in the past five years or no less than 600 hours in the past two years in the specialty area must be met or the process described in 8.11.4 followed. 8.11.6An application for reinstatement of licensure must be filed and the appropriate fee paid. 8.12Audit of Licensees 8.12.1The Board may select licensees for audit two months prior to renewal in any biennium. The Board shall notify the licensees that they are to be audited for compliance of having a collaborative agreement. 8.12.1.1Upon receipt of such notice, the licensee must submit a copy of a current collaborative agreement(s) within three weeks of receipt of the notice. 8.12.1.2The Board shall notify the licensee of the results of the audit immediately following the Board meeting at which the audits are reviewed. 8.12.1.3An unsatisfactory audit shall result in Board action. 8.12.1.4Failure to notify the Board of a change in mailing address will not absolve the licensee from audit requirements. 8.12.2The Board may select licensees for audit throughout the biennium. 8.13Exceptions to the Requirements to Practice 8.13.1The requirements set forth in 8.9 shall not apply to a Registered Nurse who is duly enrolled as a bona fide student in an approved educational program for Advanced Practice Nurses as long as the practice is confined to the educational requirements of the program and is under the direct supervision of a qualified instructor. 8.14Definitions 8.14.1Collaborative Agreement - Includes 8.14.1.1A true collegial agreement between two parties where mutual goal setting, access, authority, and responsibility for actions belong to individual parties and there is a conviction to the belief that this collaborative agreement will continue to enhance patient outcomes and 8.14.1.2A written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a duly licensed Delaware physician, dentist, podiatrist or licensed Delaware health care delivery system. This document can include, but not be limited to, written verification of health care facility approved clinical privileges or a health care facility approved job description of the A.P.N. If the agreement is with a licensed Delaware health care delivery system, the individual will have to show that the system will supply appropriate medical back-up for purposes of consultation and referral. 8.14.2National Certification - That credential earned by an Advanced Practice Nurse who has met requirements of a Board of Nursing approved certifying agency. 8.14.3Pharmacology/Pharmacotherapeutics - refers to any course, program, or offering that would include, but not be limited to, the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success, their dosages, their side-effects and their interactions. It also encompasses clinical judgement skills and decision making. These skills may be based on thorough interviewing, history taking, physical assessment, test selection and interpretation, patho-physiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non- pharmacologic interventions. 8.14.4Prescription Order - includes the prescription date, the name of the patient, the name, address, area of specialization and business telephone number of the advanced practice nurse prescriber, the name, strength, quantity, directions for use, and number of refills of the drug product or device prescribed, and must bear the name and prescriber ID number of the advanced practice nurse prescriber, and when applicable, prescriber’s D.E.A. number and signature. There must be lines provided to show whether the prescription must be dispensed as written or substitution is permitted. 8.15Requirements for Initial Independent Practice/ prescriptive Authority An APN who has not had independent prescriptive authority within the past two years in Delaware or any other jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.15.1Be an Advanced Practice Nurse (APN) holding a current permanent license issued by the Board of Nursing (BON). If the individual does not hold national certification, eligibility will be determined on a case by case basis. 8.15.2Have completed a post basic advanced practice nursing program that meets the criteria as established in Section 4.7 of Article 7 of the Rules and Regulations of the Delaware Board of Nursing with documentation of academic courses in advanced health assessment, diagnosis and management of problems within the clinical specialty, advanced patho-physiology and advanced pharmacology/ pharmacotherapeutics. In the absence of transcript verification of the aforementioned courses, applicants shall show evidence of content integration through course descriptions, course syllabi, or correspondence from school officials. If the applicant cannot produce the required documentation, such applicant may petition the Joint Practice Committee for consideration of documented equivalent independent prescriptive authority experience. 8.15.3Submit a copy of the current collaborative agreement to the Joint Practice Committee (JPC). The collaborative agreement(s) shall include arrangements for consultation, referral and/or hospitalization complementary to the area of the nurse's independent practice. 8.15.4Show evidence of the equivalent of at least thirty hours of advanced pharmacology and pharmacotherapeutics related continuing education within the two years prior to application for independent practice and/or independent prescriptive authority. This may be continuing education programs or a three credit, semester long graduate level course. The thirty hours may also occur during the generic APN program as integrated content as long as this can be documented to the JPC. All offerings will be reviewed and approved by the JPC. 8.15.5Demonstrate how submitted continuing education offerings relate to pharmacology and therapeutics within their area of specialty. This can be done by submitting the program titles to show content and dates attended. If the JPC questions the relevance of the offerings, the applicant must have available program descriptions, and/ or learner objectives, and/or program outlines for submission to the JPC for their review and approval. 8.16Requirements for Independent Practice/ prescriptive Authority by Endorsement An APN who has had prescriptive authority in another jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.16.1Show evidence of meeting 8.15.1 and 8.15.3. 8.16.2Show evidence of having current prescriptive authority in another jurisdiction. 8.16.3Have no encumbered APN designation(s) in any jurisdiction. 8.16.4Show evidence of completion of a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure within the past two years. 8.17Application 8.17.1Names and credentials of qualified applicants will be forwarded to the Joint Practice Committee for approval and then forwarded to the Board of Medical Practice for review and final approval. 8.18Prescriptive Authority 8.18.1APNs may prescribe, administer, and dispense legend medications including Schedule II - V controlled substances, (as defined in the Controlled Substance Act and labeled in compliance with 24 Del.C. §2536(C), parenteral medications, medical therapeutics, devices and diagnostics. 8.18.2APNs will be assigned a provider identifier number as outlined by the Division of Professional Regulation. 8.18.3Controlled Substances registration will be as follows: 8.18.3.1APNs must register with the Drug Enforcement Agency and use such DEA number for controlled substance prescriptions. 8.18.3.2APNs must register biennially with the Office of Narcotics and Dangerous Drugs in accordance with 16 Del.C. §4732(a). 8.18.4APNs may request and issue professional samples of legend, including schedule II-V controlled substances, and over-the-counter medications that must be labeled in compliance with 24 Del.C. §2536(C). 8.18.5APNs may give verbal prescription orders. 8.19Prescriptive Writing 8.19.1All prescription orders will be written as defined by the Delaware Board of Pharmacy as defined in 8.14.4. 8.20Renewal 8.20.1Maintain current APN licensure. 8.20.2Maintain competency through a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure per biennium. The pharmacology/pharmacotherapeutics content may be a separate course or integrated within other offerings. 8.21Disciplinary Proceedings 8.21.1Pursuant to 24 Del.C. §1906(19)(c), the Joint Practice Committee is statutorily empowered, with the approval of the Board of Medical Practice, to grant independent practice and/or prescriptive authority to nurses who qualify for such authority. The Joint Practice Committee is also empowered to restrict, suspend or revoke such authority also with the approval of the Board of Medical Practice. 8.21.2Independent practice or prescriptive authority may be restricted, suspended or revoked where the nurse has been found to have committed unprofessional conduct in his or her independent practice or prescriptive authority or if his or her mental or physical faculties have changed or deteriorated in such a manner as to create an inability to practice or prescribe with reasonable skill or safety to patients. 8.21.3Unprofessional conduct, for purposes of restriction, suspension or revocation of independent practice or prescriptive authority shall include but not be limited to: 8.21.3.1The use or attempted use of any false, fraudulent or forged statement or document or use of any fraudulent, deceitful, dishonest or immoral practice in connection with any acquisition or use of independent practice or prescriptive authority; 8.21.3.2Conviction of a felony; 8.21.3.3Any dishonorable or unethical conduct likely to deceive, defraud or harm the public; 8.21.3.4Use, distribution or prescription of any drugs or medical devices other than for therapeutic or diagnostic purposes; 8.21.3.5Misconduct, incompetence, or gross negligence in connection with independent or prescriptive practice; 8.21.3.6Unjustified failure upon request to divulge information relevant to authorization or competence to independently practice or exercise prescriptive authority to the Executive Director of the Board of Nursing or to anyone designated by him or her to request such information. 8.21.3.7The violation of the Nurse Practice Act or of an Order or Regulation of the Board of Nursing or the Board of Medical Practice related to independent practice or prescriptive authority. 8.21.3.8Restriction, suspension, or revocation of independent practice or prescriptive authority granted by another licensing authority in any state, territory or federal agency. 8.21.4Complaints concerning the use or misuse of independent practice or prescriptive authority received by the Division of Professional Regulation or the Board of Nursing shall be investigated in accordance with the provisions of Title 29, Section 8807 governing investigations by the Division of Professional Regulation. As soon as convenience permits, the Board of Nursing shall assign an Investigating Board Member to assist with the investigation of the complaint. The Investigating Board Member shall, whenever practical, be a member of the Joint Practice Committee. 8.21.5Upon receipt of a formal complaint from the Office of the Attorney General seeking the revocation, suspension or restriction of independent practice or prescriptive authority, the Committee Chairperson shall promptly arrange for not less than a quorum of the Committee to convene for an evidentiary hearing concerning such complaint upon due notice to the licensee against whom the complaint has been filed. Such notice shall comply with the provisions of the Administrative Procedures Act (29Del.C. Ch. 101). 8.21.6The hearing shall be conducted in accordance with the Administrative Procedures Act (29Del.C. §101), and after the conclusion thereof, the Joint Practice Committee will promptly issue a written Decision and Order which shall be based upon the affirmative vote of a majority of the quorum hearing the case. 8.21.7Any written Decision and Order of the Joint Practice Committee which imposes a restriction, suspension or revocation of independent practice or prescriptive authority shall not be effective prior to the approval of the Board of Medical Practice. 4 DE Reg. 296 (8/1/00) 5 DE Reg. 1606 (2/1/02) *Please Note: As the rest of the sections were not amended they are not being published. A complete set of the rules and regulations for the Board of Nursing is available at: http://dpr.delaware.gov/boards/nursing/index.shtml DIVISION OF PROFESSIONAL REGULATION 2600 BOARD OF PHYSICAL THERAPISTS AND ATHLETIC TRAINERS Statutory Authority: 24 Delaware Code, Section 2604(1) (24 Del.C. §2604(1)) 24 DE Admin. Code 2600 PUBLIC NOTICE The Delaware Examining Board of Physical Therapists and Athletic Trainers in accordance with 24 Del.C. §2604(1) has proposed changes to its rules and regulations as the result of statutory amendments due to the enactment of SB 292. The proposal amends the rules to reflect the current practice of athletic training. A public hearing will be held on April 19, 2005 at 6:30 p.m. in the second floor conference room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware where members of the public can offer comments. Anyone wishing to receive a copy of the proposed rules and regulations may obtain a copy from the Delaware Examining Board of Physical Therapists and Athletic Trainers, 861 Silver Lake Blvd, Cannon Building, Suite 203, Dover DE 19904. Persons wishing to submit written comments may forward these to the Board at the above address. The final date to receive written comments will be at the public hearing. The Board will consider adopting the proposed amendments to its regulations at its regularly scheduled meeting following the public hearing. The proposed amendments are set forth below: 1.0Definitions 1.1Consultation (24 Del.C. §2612) 1.1.1Consultation in direct access. A licensed health practitioner who has been granted prescriptive authority must be consulted if a patient is still receiving physical therapy after 30 calendar days have lapsed from the date of the initial assessment. This consultation must be documented and could take place at any time during the initial thirty day period. The consultation can be made by telephone, fax, in writing, or in person. There is nothing in these rules and regulations or in the Physical Therapy Law that limits the number of consultations the Physical Therapist can make on the patient’s behalf. The consult should be with the patient’s personal licensed health practitioner. If the patient does not have a personal licensed health practitioner, the Physical Therapist is to offer the patient at least three licensed health practitioner from which to choose. The referral to a licensed health practitioner after the initial thirty day period must not be in conflict with 24Del.C. §2616(a)(8) which deals with referral for profit. If no licensed health practitioner consult has been made in this initial thirty day period, treatment must be terminated and no treatment may be resumed without a licensed health practitioner consult. 1.1.2Consultation with written prescription from a licensed health practitioner. A prescription accompanying a patient must not be substantially modified without documented consultation with the referring practitioner. The consultation can be made by telephone, fax, in writing, or in person. 1.2Direct Supervision (24 Del.C. §2611(a)) 1.2.1Direct supervision in connection with a Physical Therapist or Athletic Trainer practicing under a temporary license means: 1.2.1.1a licensed Physical Therapist or Athletic Trainer supervisor shall be on the premises when the individual with a temporary license is practicing and 1.2.1.2evaluations and progress notes written by the individual with a temporary license shall be co-signed by the licensed Physical Therapist supervisor. 1.2.2Direct supervision in relation to a Physical Therapist Assistant with less than one (1) year experience means a Physical Therapist shall be on the premises at all times and see each patient. 1.2.3Direct supervision in relation to a Physical Therapist Assistant with one (1) year or more experience means that a Physical Therapist Assistant must receive on- site, face to face supervision at least once every fifth treatment day or once every three weeks, whichever occurs first. The supervising Physical Therapist must have at least one (1) year clinical experience. The Physical Therapist must be available and accessible by telecommunications to the Physical Therapist Assistant during all working hours of the Physical Therapist Assistant. 1.2.4The Physical Therapist is responsible for the actions of the Physical Therapist Assistant or the Athletic Trainer when under his/ her supervision. All supervision must be documented. 1.2.5Direct supervision in connection with an athletic trainer in a non-clinical setting means that the supervising athletic trainer should be personally present and immediately available to the treatment area. Direct supervision in connection with an Athletic Trainer treating an injury not defined as an 'athletic injury', which must be a musculoskeletal disorder if seen for physical therapy when the athletic trainer has one (1) year or more of continuous experience means that an Athletic Trainer must receive on-